G801 – Hyperbaric oxygen therapy - after first 1/4 hour
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Hyperbaric Oxygen Therapy (HBOT) is the service rendered when a physician administers and supervises HBOT. Time is calculated based on the period of physician supervision while each patient receives HBOT inside the chamber. The specific elements of HBOT are those of an assessment, including ongoing monitoring of the patient's condition and intervening as appropriate. This code, G801, is for each quarter-hour or major part thereof of physician attendance in the chamber with the patient, after the first quarter-hour. This service is billed in sequence after G800 and is applicable for up to 2 hours of total chamber time. For time exceeding 2 hours, G802 is used.
When to Use
- Use G801 for each 15-minute increment of physician supervision following the initial 15 minutes billed under G800, up to a maximum of 2 hours total.
- Apply G801 when providing continuous monitoring and assessment of a patient during HBOT sessions for ministry-approved indications like ISSHL or AVN.
Common Pitfalls
- Billing G801 for time beyond the 2-hour threshold, which must be transitioned to G802 to avoid rejection.
- Failing to document precise start and stop times in the medical record, which is a mandatory requirement for audit compliance.
- Overlapping G801 with other procedures that are not explicitly permitted to be billed concurrently while inside the chamber.
Billing Tips
- Ensure the total time billed across G800 and G801 does not exceed 120 minutes; any time beyond this must be claimed using G802.
- When treating multiple patients, ensure the time billed reflects the actual physician supervision time per patient rather than the total duration of the chamber cycle.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
The service is eligible for payment only if the start and stop times of the service are recorded in each patient's permanent medical record.
HBOT is insured only for the treatment of those internationally recognized indications approved by the ministry.
HBOT is only eligible for payment for idiopathic sudden sensorineural hearing loss (ISSHL) when the following conditions are met: a. The patient is treated concurrently with corticosteroid unless corticosteroids are contraindicated; b. The treatment is initiated within 30 days of a diagnosis of ISSHL; and c. The diagnosis of ISSHL is made or confirmed by an Otolaryngologist prior to the initiation of treatment.
HBOT is only eligible for payment for avascular necrosis (AVN) of bone following diagnostic imaging confirmation of symptomatic early to mid-stage AVN, e.g. Ficat stage I, II, or III or equivalent.
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